局部晚期非小细胞肺癌同步放化疗规范

局部晚期非小细胞肺癌占就诊肺癌的1/3以上,近几年的多中心随机研究和荟萃分析表明化放综合治疗优于单纯放疗或单纯化疗,与手术效果相似,同步放化疗优于序贯放化疗。同步放化疗适合于一般情况好、70岁以下的患者,有严重内科疾病的患者不宜采用同步放化疗。同步放化疗中放疗规范包括正确的定位、CTV勾画等,不必进行淋巴结预防照射。其中的化疗方案包括CE、TP、DP、GP等,总化疗周期不应超过4个周期,同步放化疗前不必进行诱导化疗,同步放化疗后的巩固化疗尚存争议。多种含铂化疗方案的比较显示疗效相近,每周和每日方案比较疗效及毒性相似。培美曲塞加卡铂是可选择的新的化疗方案。同步放化疗在治疗开始进行好于诱导化疗后进行,与分子靶向药物联合是新的治疗方向。

Standardization of concurrent radiochemotherapy in locally advanced NSCLC

Locally advanced NSCLC accounts for more than one third of lung cancers at the initial diagnosis. In recent years,some multi-center randomized studies and meta-analysis show that the multi -modality therapy that combines radiotherapy and chemotherapy is superior to radiotherapy or chemotherapy alone,with the similar effectiveness as surgery;furthmore,concurrent radiotherapy and chemotherapy is superior to the sequential approach.Concurrent radiochemotherapy is suitable for patient with good general conditions and is less than 70 years.Patients with serious medical conditions should not receive concurrent radiochemotherapy.The requirements of radiotherapy methods in concurrent radiochemotherapy include the correct position and CTV delineation.Prophylactic lymph node irradiation is unnecessary. The chemotherapy regimens of concurrent radiochemotherapy includes CE,TP,DP,and GP.The total cycles of chemotherapy should be no more than four cycles.The pre-induction chemotherapy before concurrent radiochemotherapy is unnecessary and the consolidation chemotherapy after concurrent radiochemotherapy remains controversial.The varieties of platinum-based chemotherapy regimens have showed similar efficacies.The weekly schemes have similar efficacies and toxicities with the daily schemes.Pemetrexed combined with carboplatin is a new alternative scheme.Concurrent radiochemotherapy initialed at the beginning of the treatment is better than to be performed after induction chemotherapy.Concurrent radiochemotherapy combined with molecular targeted drugs is a new therapeutical direction.